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Special Report: The Green ED Cuts Costs – and Helps the Planet

2012; Lippincott Williams & Wilkins; Volume: 34; Issue: 4 Linguagem: Inglês

10.1097/01.eem.0000413875.82056.1c

1552-3624

Anne Scheck,

Environmental Impact and Sustainability

Most exam rooms have outside windows to allow in natural light in the emergency department at Providence Newberg Medical Center: .The greenest hospital in the nation is also gold, and it is giving the emergency department there a whole new luster. Providence Newberg Medical Center near Portland, OR, clinched gold LEED certification by the U.S. Green Building Council more than five years ago, and it is still topping a growing list of energy-efficient hospitals. Twenty-five percent or more of the energy demand can be cut, according to estimates there. And the bonus is that Press Ganey scores are through the roof, as is employee morale, which brightened right along with the new access to natural light. LEED — Leadership in Energy and Environmental Design — is a certification process that promotes environmentally friendly and more energy-efficient construction. The U.S Green Building Council confers the designation, with platinum the highest level of attainment. LEED certification provides independent, third-party verification that a building was designed and built using strategies aimed at achieving high performance in human and environmental health such as sustainable site development, water savings, energy efficiency, materials selection, and indoor environmental quality, and LEED-certified facilities are eligible for grants, rebates, and tax breaks. (See FastLinks.) The break area in the old Providence Newberg ED, for example, was four walls and a door. Now it looks out onto a landscape of natural vegetation, said Julia Florea, MSN, the manager of emergency services for the medical center. Countering the opinion of an amphibious Muppet known for declaring it's not easy being green, the staff at Providence Newberg say it's not only easy, it's quite pleasant, too. Outdoor light is captured as much as possible, including in most ED patient-exam rooms and by way of glass walling in other areas, such as in the café. “We have the best views in town,” said Michael Antrim, who heads up marketing there. “Nothing beats it,” he said, gesturing to the cafe's sun-illuminated room, where tulip lights dangle overhead, their sensors triggered only on darker days. Just outside the café, tuffets of grass and sedge help mark a path through the Healing Garden against a backdrop of distant turquoise hills. The design was undertaken several years ago before low-energy tools and materials were available in many stores that now stock them, he said. Paints and coatings low in volatile organic compounds (VOCs) had to be sought out, and so did carpeting and wood with the same properties. “It was a whole different time,” Mr. Antrim said. “Now you just walk into Home Depot, and you see the very things we strived to make part of this.” Renewable power runs the entire medical center through a combination of wind, geothermal, and hydroelectric energy. In fact, Providence Newberg is so much greener than most of its counterparts across the nation that it might be tempting to dismiss it as just one more sign, in the ever-so-ecologically-focused Pacific Northwest, that going green is simply part of a cultural adherence, not savvy corporate decision-making.The cafe for staff and patients at Providence Newberg Medical Center lets in natural light and looks out over a soothing landscape: .After all, nearly a decade ago, the New York Times weighed in with news that specialists in real estate, finance, design, and construction found no compelling evidence of economic reward from building environmentally conscious, energy-sparing structures. Even though accumulating research was showing that such findings might not survive the test of time, another examination of the industry during the same period showed such efforts were beginning to pay off. That report conceded the difficulty measuring “the exact financial impact of healthier, more comfortable, and greener buildings.” But it raised the specter of costs that are often overlooked — poor indoor air quality and a closed-in feeling. The former can lead to higher absenteeism due to increased respiratory problems such as allergy flare-ups and asthma exacerbations; the latter can influence psychological satisfaction with the workplace, and is difficult to measure and generally hidden in sick days and lower productivity, the researchers found. (“Green Building Costs and Financial Benefits.” MIT Collaborative; 2003. See FastLinks.) In fact, four of the attributes associated with green-building design — increased ventilation control, better temperature control, more lighting control, and increased daylight exposure — have been positively and significantly correlated with increased productivity, according to the report, which attributed a one percent productivity and health gain to certified and silver-level buildings and a 1.5 percent gain of these factors to gold- and platinum-level buildings. Employee happiness from improved ambience may be difficult to quantify, but “we hear about this all the time,” said Mitchell Breeze, the director of general support services at Community Hospital South in Indianapolis. There a new ED was constructed with a let-there-be-light philosophy, among other energy-conserving objectives, such as harnessing the power from exiting air in the ventilation system, which previously was allowed to escape. The nurses' station, for example, now sits in a pool of light on sunny days, the result of a light well overhead that traps sunshine like a skylight but looks more like a glass elevator shaft. Like the ED at Providence Newberg, lots of windows provide easy views to the outside. A fountain gurgles year-round in the hospital's version of a healing garden, a xeriscape with plants like daylilies and sumac, which were chosen for their low-water usage and visual appeal. Even these changes proved sometimes problematic. In one area of the terrain near a natural riparian section, the plants grow so thick that groundskeepers sometimes mistake them for weeds, and whack away at them, said Mr. Breeze. “Fortunately, my window overlooks that part, and when I see the crew coming I just hurry down to make sure it doesn't occur.” High patient satisfaction scores suggest that patients also like the new atmosphere, said Mr. Antrim at Providence Newberg. Online survey results show that satisfaction ratings with rooms and noise level increased 11 percent and nine percent, respectively, after the construction. Do people really care about whether the place they are visiting or staying is green? Yes, with a few caveats: They want convenience and comfort, too. “Change is not always easy,” Ms. Florea said on a recent tour of the ED at Providence Newberg. Design for the new ED was a radical departure from the old one, geographically and philosophically. The old one in a former hospital near the center of town was rebuilt on the outskirts of the city. Fortunately, it had features the staff wanted to abandon completely, such as narrow halls and windowless rooms, which made the transition a positive one, said Ms. Florea. Nurses and physicians got the chance to put their own stamp on the new facility, working directly with the building team, including periodically reviewing the architectural plans. “There was a mock-up, and that was most helpful,” Ms. Florea noted. “We could say, ‘No, this isn't quite right here. We need more space,’ or make suggestions about how something should look,” she said. Flow definitely improved, making the average length of stay 128 minutes for the 20,000 annual patient visits. Boarding generally is used only for psychiatric patients, and a pair of triage rooms have made processing much easier, Ms. Florea said. That has positively affected patient satisfaction and staff morale, she said. And it has paid off as a recruitment tool, too. “People come through and say, ‘It feels so nice in here,’” she noted. At Providence Newberg, the effort paid off financially as well in short-term savings because federal grants chipped away at the overall cost and in the long-term, too, because energy expenses were reduced by 25 percent to 35 percent over what would be expected in more conventional construction, Mr. Antrim noted. But the payoff in other ways was even more dramatic, he said. National coverage of the achievement generated buzz, and “going green” became part of the medical center's identity. “This got everyone in a mindset,” he explained. As a result, a top-to-bottom approach created a healthier environment: Television sets were ruled out in waiting areas, with the lone exception being the emergency department. Ditto for routine announcements from an overhead speaker except in urgent situations. “We tried to take into account all the aesthetic factors” and also the advantages of new technology, he said. “There is not much paging because that can be done by cell phone or some other device.” The idea is one that organizational psychologists have long dubbed “group modeling,” and it is being extended to the workplace. Researchers are looking at how places make people feel connected, a concept known as “attachment to area,” and the impact it can have on the surrounding attitude and culture. (Person-Environment–Behavior Research. New York; 2009.) In fact, four of eight of the greatest wasters in EDs — overprocessing, overproduction, too much inventory, and low use of personnel creativity — are all related to human factors and subject to environmental influence. (The Definitive Guide to ED Operational Improvement; London: Productivity Press, 2011.) Green design can yield savings of $50 to $70 per square foot, according to surveys on existing LEED facilities, though that is likely to increase because green design costs tend to drop as the demand for green construction rises. This trend of “declining costs associated with increased experience in green building construction has been experienced in Pennsylvania as well as in Portland and Seattle,” according to green practices analyst Gregory H. Kats, the founder of the American Council on Renewable Energy. (“Green Building Costs and Financial Benefits,” MIT Collaborative; see FastLinks.) Portland's three completed LEED Silver buildings, finished in 1995, 1997, and 2000, incurred cost premiums of two percent, one percent, and zero, respectively. Meanwhile, in Seattle,the cost of LEED Silver buildings dropped from about four percent to about two percent over about the same period, according to the study. Click and Connect!Access the links in EMN by reading this issue on our website or in our new app for the iPad, both available atwww.EM-News.com. North Carolina's Lean, Green EMS Machine No area of emergency medicine is as ripe for green innovations as EMS, especially with emergency response vehicles representing one of the highest costs for local governments. Seth Hawkins, MD, the medical director of Burke County EMS in North Carolina, studied EMS vehicles with this in mind, ultimately finding that excuses not to use greener rigs just didn't hold up. (JEMS 2008;33[7]:108.) Burke County EMS purchased a midsize hybrid electrical-gasoline SUV quick response vehicle to see if it would perform as well as a traditional EMS vehicle. Concerns were myriad. Was there enough cargo space? Could a hybrid support the electrical needs of lights and sirens? Was the hybrid engine reliable enough for emergency responses? Would it operate well in a rugged rural environment with frequent wilderness EMS responses? The study tested a 2006 4WD Escape Hybrid, the second most environmentally clean midsize SUV of 189 ranked by the EPA, the first being the same vehicle's 2WD version. It averaged approximately 25 mpg in the city and 27 mpg on the highway. “The study vehicle never appeared to be underpowered,” wrote Dr. Hawkins, also the EMS coordinator for Blue Ridge HealthCare in Morganton, NC, and an assistant professor in the emergency care program at Western Carolina University. “It's a common myth that hybrids are slow or have less acceleration. On the contrary, most hybrids accelerate faster than non-hybrid equivalents.” Though the vehicle had less interior cargo space — 65.5 cubic feet compared with a Chevrolet TrailBlazer's 80 cubic feet — that didn't pose a problem, Dr. Hawkins noted. Running lights and sirens on the hybrid was also supported without difficulty because a hybrid actually has more electrical power than its traditional equivalent. The hybrid also reduced noise pollution because no diesel engine was humming in the field or the ambulance bay. The hybrid vehicle was 10 percent less expensive to purchase, operated at approximately half the annual fuel costs, and emitted approximately 50 percent less greenhouse gases compared with traditional EMS quick response vehicles. “It appears that EMS vehicles can and should be operated with much higher fuel efficiency and much lower environmental impact,” Dr. Hawkins said. FastLinks Only inEMN's iPad App: Watch a video explaining how Community Hospital South went green. Learn more about LEED certification through the U.S Green Building Council website at http://bit.ly/LEEDcertification. The MIT Collaborative report, “Green Building Costs and Financial Benefits,” is available at http://bit.ly/MITGreen. Read Dr. Seth Hawkins EMS vehicle study at http://bit.ly/GreenEMS. Bonus articles! Read “Lessons Learned from Going Green” and “ISIS Promotes Sustainability in Emergency Services” in the EM-News.com Breaking News Blog: http://bit.ly/EMNBreakingNews. Comments about this article? Write to EMN at [email protected]